No abstract

On the basis of observations in 117 children with cystic fibrosis, seen from January 1956 to June 1976, it is demonstrated that the relative underweight (weight loss corrected for height) is most pronounced in children with predominantly pulmonary sypmtoms. The degree of underweight closely correlates inversely with survival. Because of its prognostic value, it is recommended that this clinical parameter be included in the checkups which are periodically carried out on children suffering from cystic fibrosis.

No abstract

Conclusion:In patients with a hemodialysis access graft and an asymptomatic central venous stenosis (CVS) of Ͼ50%, treatment of the CVS results in more rapid stenosis progression compared with a nontreatment approach.Summary: The authors evaluated the natural history of Ͼ50% asymptomatic CVSs in hemodialysis patients. Outcome of serial treatment of CVS with percutaneous catheter-based techniques (PTA) was also evaluated. All patients in this study required maintenance procedures for their dialysis access.Between 1998 and 2004, 35 patients (19 men, 16 women), with a mean age of 58.7 years, were found to have asymptomatic CVS of Ͼ50%. CVS was measured by using venograms obtained before and after PTA. Patients with arm swelling, multiple CVSs, or indwelling catheters, were excluded. CVS progression was calculated by comparing degrees of stenoses with serial venographic examinations.The mean severity of CVSs before intervention was 71% (range, 50% to 100%), with 62% of lesions having associated collateral vessels. Twenty eight percent of CVSs were not treated. The mean degree of stenosis in the untreated group was 72% (range, 30% to 100%). Mean progression of stenosis in the untreated group was -0.8% point per day. No untreated CVS progressed to symptoms, stent placement, or developed additional CVS.PTA was used to treat 62 CVS lesions (72%). The mean degree of stenosis in the treated group was 74% (range, 50% to 100%) before and 40% (range, 0% to 75%) after treatment. In the treated group, mean progression of CVS was 0.21% per day after treatment. Six of the 62 treated CVS lesions were monitored, with symptomatic escalation of the CVS as manifested by arm swelling, need for stent placement, or development of additional CVS lesions.Comment: Treatment of an asymptomatic CVS in a dialysis patient is not a good thing. One is reminded of the old adage that it is wise to avoid poking a skunk. A major weakness of this study is that the patients were undergoing maintenance procedures for their dialysis access. We do not know if the CVS contributed to the need for the dialysis access maintenance. It would be interesting to know if there was a higher rate of repeat procedures for maintenance of dialysis access in patients with treated vs untreated CVS.

ExtractSingle sweat droplets were collected from a mineral oil-covered finger surface ( fig. 1). Rate of sweat production (sweat rate) per gland per hour was calculated. Using microtechniques, the concentrations of electrolytes and metabolites, osmolarity, pH, and viscosity were determined in undiluted pooled sweat. The following results were obtained:No significant difference was observed in sweat rate per gland between control subjects and patients with cystic fibrosis of the pancreas (CFP).Concentrations of sodium and chloride in sweat rose with increasing sweat rates in both control subjects and patients with CFP. In the patients with CFP, the lowest values were between 70 and 90 mEq/1 and the curve approached isotonicity. Chloride values were consistently lower than those of sodium. Concentrations of potassium decreased with increasing sweat rate in control subjects approaching a value of about 10 mEq/1. In patients with CFP, the values for potassium were frequently twice as high as those in the control subjects. Concentration of calcium dropped rapidly with an increasing sweat rate from 10 to 1-2 mEq/1.Concentrations of lactic acid and urea were high at low sweat rates and decreased hyperbolically with increasing rates. In patients with CFP, the values of both components were lower than those in control subjects. Urea was uniformly more concentrated in sweat than in plasma; the sweat:plasma ratio approached 1.0 with increasing sweat rates.Creatinine concentrations decreased with increasing sweat rate. No difference was observed between values in two patients and two control subjects. Glucose concentration was low (0.2-6 mg/100 ml) and was independent of the sweat rate. No significant difference was observed in comparing five patients with CFP and six control subjects.In control subjects, osmolarity decreased, with increasing sweat rate, from 240 to approximately 120 mOsmol/1 and then increased (mean 163 mOsmol/1). In patients with CFP, the curve was similar in shape but began and ended in a range of approximately 320 m/Osmol/1 (mean 299 mOsmol/1).The pH of sweat was acid at low sweat rates (pH 3.5-6.0) and was slightly alkaline (pH 7.0-8.5) at high rates. No differences were observed when comparing five patients and five control subjects.Viscosity of sweat was significantly elevated in five patients with CFP in relation to that observed in eight control subjects. This may be explained by the elevated concentration of salt in sweat of patients with CFP.The excretory pattern of urea, lactic acid, and creatinine in sweat of patients with CFP, compared with that of control subjects, argues against an increased rate of water reabsorption in the excretory ducts of the sweat gland. The course of the sodium and the chloride curve and the values of osmolarity EMRICH, STOLL, FRIOLET, COLOMBO, RIGHTERIGH, ROSSI 465 in sweat favor the assumption that in cystic fibrosis of the pancreas, the precursor fluid is in the isotonic range; net sodium reabsorption can then be calculated and appears to be defective in patients w...

No abstract

No abstract

No abstract